New motion capture screening technology could slow progression of arthritis

Most people don’t think about their thumbs very often. But for people living with advancing arthritis, the simplest thumb movements—from grasping a cup to sending a text message—can be painful and incredibly challenging.

That’s why Michigan State University researchers set out to see if they could use motion capture technology to screen for differences between healthy hand movements and those in patients with osteoarthritis, or OA. This method could potentially detect arthritis earlier, possibly delaying and preventing the loss of thumb function. In turn, that could save arthritis patients from surgery and even being forced into assisted living.

The team’s research is published in Clinical Biomechanics.

“Our work suggests that three-dimensional motion tasks may be able to identify OA-associated motion deficits earlier than the two-dimensional motion tasks typically used in a clinical setting,” said Amber Vocelle, co-author on the research and a DO/Ph.D. student in the College of Osteopathic Medicine. “By identifying the disease earlier, we can treat OA earlier in the disease process.”

According to Vocelle, therapists and clinicians traditionally use goniometers, simple two-dimensional measurement tools, along with basic movements to screen for reduced hand function due to OA. But the results can vary depending on who’s doing the measuring, making it hard to track reliably over time.

“There are pieces of information that aren’t being gathered right now that could be useful for early prediction of OA of the thumb, or setting up thresholds to define when people should consider doing therapy before they’re in severe pain,” said Tamara Reid Bush, an associate professor of mechanical engineering in the College of Engineering who also worked on the research.

In contrast, motion capture technology records precise, objective measurements in three dimensions.

Both Bush and Vocelle, along with Gail Shafer, an assistant professor in the College of Human Medicine, put markers on participants’ hands, which were then monitored by motion capture technology as they went through a series of three-dimensional thumb movements. Differences between healthy and OA-diagnosed patients were observed.

The thumb isn’t usually looked at in isolation with reference to OA, but this research may be changing that.

“Thumbs aren’t just important for people playing the piano or knitting for fun. Almost everything you do on a daily basis involves the thumb in some way, shape or form,” Bush added.

Forthcoming research from the trio will look at how a six-week thumb exercise protocol impacted the ability to generate forces with the thumb. The researchers observed an increase in thumb strength in just two weeks.

So where could this go next? One avenue would be to develop tools for conducting these three-dimensional measurements in-clinic without the need for laboratory-grade motion capture devices. That would give therapists the ability to not only evaluate more complex movement patterns for earlier diagnosis, but also measure the impact of treatment for better outcomes.

This type of collaboration between research specialties can be difficult to pull off, but Vocelle’s rotations as part of her DO/Ph.D. program presented a meaningful opportunity for integration. The three combined Vocelle’s clinical knowledge, Shafer’s rehabilitation expertise, and Bush’s deep understanding of biomechanics to offer a fresh perspective on a long-standing clinical problem.

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LGBT-friendly primary care improves STD screening rates

(HealthDay)—A quality improvement initiative that enhances lesbian, gay, bisexual, and transgender (LGBT) affirming care also improves screening rates for sexually transmitted diseases, according to a study published in the July/August issue of the Annals of Family Medicine.

Bruce W. Furness, M.D., M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues developed and evaluated a quality improvement initiative (Transforming Primary Care for LGBT People) to enhance the capacity of 10 federally qualified health centers (FQHCs; 123 clinical sites in nine states) to provide culturally affirming care.

The researchers found that FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9 percent increase) and identifying LGBT patient liaisons (300.0 percent increase). Based on sexual orientation and gender identity (SOGI) from electronic health records among nine FQHCs, SOGI documentation increased from 13.5 to 50.8 percent of patients. Screening of LGBT patients increased from 22.3 to 34.6 percent for syphilis, from 25.3 to 44.1 percent for chlamydia and gonorrhea, and from 14.8 to 30.5 percent for HIV among the eight FQHCs reporting the number of LGBT patients.

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GPs text messages boost cervical screening uptake

Sending a text message reminder can lead to more women taking up cervical screening, new research has shown.

In a study of almost 15,000 women in Northwest London, SMS reminders increased cervical screening participation by around five percent.

Based on these findings, the NHS rolled out text message reminders across London in late 2018 for a six-month trial, which saw a similar rise of 4.8 percent in cervical screening uptake. That is the equivalent of 13,400 more women being screened as a result of the campaign.

Cervical screening can help save lives by spotting harmful or potentially harmful changes in cervical cells earlier, meaning women can get access to treatment when it’s more likely to be effective. This means that cervical screening can lead to better outcomes for women, as well as helping to prevent cervical cancer.

But cervical screening rates have been falling in Britain. To address this, a team from Warwick Business School, Imperial College, Public Health England, UCL and Imperial College Healthcare NHS Trust explored whether sending a text to remind women that their smear test is due could encourage more people to make and attend an appointment.

Ivo Vlaev, Professor of Behavioural Science at Warwick Business School, said: “We very much hope the rest of the country implements this revolutionary behavioural approach as soon as possible.

“Our study suggests that messages endorsed by a person’s GP can be effective at increasing cervical screening uptake, but also that a simple reminder can be as good as or better than many other type of messages that we studied.

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“We’re delighted that our findings have already been implemented in a successful pilot campaign in London, which we hope will be extended so that more women can benefit from cervical screening, which we know saves lives. In order to make the most of the impact that SMS reminders can have on uptake, it will be important for services to have up-to-date phone numbers for their patients.”

The study, which ran from February to October in 2015, saw 14,500 women aged 24-64 participate and was supported by the London Borough of Hillingdon Clinical Commissiong Group and participating GP practices.

In the first study 3,133 women aged 24-29 were randomised to receive either no SMS, or an SMS endorsed by their GP. A second study saw a further 11,405 women aged 30-64 randomised to receive either no SMS, a standard reminder to book an appointment via text, an SMS endorsed by their GP, or one of four SMS’ using behavioural science nudges. There were social norms messages relaying the local proportion or number of women being screened.

Will nudges boost cervical cancer screening?

Then there were texts using gain-framed and loss-framed messages, with one highlighting the potential benefits of screening with the number of lives saved by screening each year and another detailing the amount of lives lost if women are not screened.

In study one, participation was higher in those who received a GP-endorsed SMS (31.4 percent) compared to those who received no SMS (26.4 percent). In study two, participation was highest in those who received a GP-endorsed SMS (38.4 percent) or a standard reminder SMS (38.1 percent), compared to no SMS (34.4 percent).

More women in the trial attended cervical screening if they received a text message, compared to those who didn’t. Rates were highest among those who received a standard reminder or a GP-endorsed text, both of which saw around a five percent increase in participation.

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Slightly more women also attended screening if they were sent a text framed around potential losses or gains, but attendance was not significantly higher than for those who were not sent a text message.

However, when the researchers excluded cases where the text was not successfully sent (determined from delivery status information), the study found that uptake was higher across all of the different SMS messages, compared to no message.

Sarah Huf, Honorary Clinical Research Fellow at Imperial’s Institute of Global Health Innovation, said: “Not only do text message reminders improve cervical screening rates, our results indicate that what we write in the message matters.

“We hope that this low-cost intervention will be adopted beyond London. Given the likely detrimental impact of the ongoing COVID-19 pandemic on cancer screening rates across the UK, simple interventions such as text message reminders could support efforts to increase cervical screening as services resume normal practice.”

As it costs around just 3p to send a text, SMS reminders would be a relatively inexpensive intervention for health systems. Although if practices don’t already have the required software, there are further costs attached to setting this up.

Based on the results of this study, the researchers are now extending their work to find out whether the specific wording of text message reminders can influence rates of breast screening.

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Researchers advise annual low-dose CT lung screening for high-risk individuals

(HealthDay)—The U.S. Preventive Services Task Force (USPSTF) recommends annual low-dose computed tomography (LDCT) screening for people aged 50 to 80 years at high lung cancer risk due to smoking history. These recommendations form the basis of a draft recommendation statement, published online July 7 by the USPSTF.

Daniel E. Jonas, M.D., M.P.H., from the RTI International-University of North Carolina at Chapel Hill, and colleagues reviewed data from seven randomized controlled trials with 86,486 participants that evaluated lung cancer screening with LDCT. The National Lung Screening Trial (NLST) and the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) were adequately powered. The researchers identified reductions in lung cancer and all-cause mortality with three rounds of annual LDCT screening versus chest X-ray for high-risk current and former smokers aged 55 to 74 years in the NLST (calculated incidence rate ratios, 0.85 and 0.93, respectively). A reduction in lung cancer mortality was seen in NELSON (calculated incidence rate ratio, 0.75) with four rounds of LDCT screening in current and former smokers aged 50 to 74 years.

Based on these findings, the USPSTF recommends annual LDCT screening for lung cancer for adults aged 50 to 80 years with a 20 pack-year smoking history and who currently smoke or who quit within the last 15 years (B recommendation).

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